Acute Myeloid Leukemia
To determine the treatment path that may be most effective for you, your doctor will consider the results of your diagnostic and specialized tests that helped determine your specific type of AML. Other factors that influence treatment planning include your age, your general health and ability to manage certain therapies, and your preferences for quality of life.
Treatment generally consists of two phases: remission induction therapy and post-remission therapy. During remission induction therapy, the goal is to destroy the leukemia cells in the blood and bone marrow, putting the AML into complete remission. Complete remission is defined as having blood counts that are back to normal, the elimination of leukemia cells in blood samples that are examined under a microscope, and no signs or symptoms of the disease.
The goal of post-remission therapy, also called consolidation therapy, is to kill any remaining leukemia cells that could cause a relapse.
The following options may be used alone or in combination.
Chemotherapy kills cancer cells, along with some healthy cells, throughout the body. To treat AML, chemotherapy may be used alone or followed by stem cell transplantation. The choice of chemotherapy drug depends on several factors, including your age (whether you are younger or older than 60), risk factors and prognosis (predicted outcome after treatment). The use of high-dose chemotherapy typically requires a lengthy hospital stay so the patient’s blood counts can be closely managed. When AML has spread to the brain and spinal cord, chemotherapy may be injected into the fluid-filled space between the thin layers of tissue that cover the brain and the spinal cord. This is called intrathecal chemotherapy.
Stem cell transplantation may be used depending on the AML subtype and if the AML is relapsed after being treated with chemotherapy alone. An allogeneic transplant is most commonly used for AML. That involves stem cells donated by a family member or an unrelated donor. To reduce the risk of Graft-versus-Host Disease (GvHD), a serious condition in which transplanted donor immune cells attack the patient, it is important the patient’s and donor’s tissues match as closely as possible.
An allogeneic transplant can work directly against the cancer through the graft-versus-tumor effect (also called graft-versus-leukemia or graft-versus-cancer-cell). This may occur when the donor’s white blood cells (the graft) attack any cancer cells (the tumor) remaining after high-dose conditioning treatments, and the effect can be key to a successful outcome.
You will benefit from the help of a caregiver post-transplant. Talk with your doctor about the potential short- and long-term side effects and the length of time you may need assistance.
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Targets include gene mutations, alterations and proteins on the cell surface. Unlike chemotherapy, which attacks healthy cells as well as cancer cells, targeted therapy is intended to affect only cancer cells.
It may be given alone or in combination with chemotherapy, depending on the presence of certain gene mutations (alterations) or specific proteins on the surface of the leukemia cells. Some AML genetic mutations treated with targeted therapy include FLT3 (pronounced “flit-three”), IDH1 and IDH2.
Radiation therapy is the use of high-energy radiation to destroy cancer cells. It is rarely used to treat AML, but it may be used if the cancer has spread to the brain, spinal fluid or testicles. Radiation therapy may also be used to shrink a collection of leukemia cells that has formed a mass somewhere. Some people with localized disease or bone pain that does not lessen with chemotherapy may receive radiation therapy to specific parts of the body. It may also be given to the entire body (total body irradiation) before stem cell transplantation to make space to allow for the new cells (graft) to replace the diseased blood system.
Leukapheresis is not a treatment for AML but may be used to treat leukostasis, which occurs when a very high number of leukemia cells are present in the blood and cause problems with normal blood circulation. During leukapheresis, blood is removed to collect leukemia cells and then the remaining blood is returned to the body. It is used to lower white blood cell counts immediately but only does so temporarily.
Growth factors are sometimes given to increase the number of white blood cells that are decreased by treatment, which can increase the risk of infection. Growth factors may be given before stem cells are collected or after chemotherapy once remission is reached.
Clinical trials may be considered for a first-line treatment (before any other treatment is given), if the current treatment is not effective or if the cancer cells become refractory. For example, an experimental treatment called CAR T-cell therapy is under intense investigation at a number of academic medical centers across the country, whereby your own T-cells are removed from the body during remission and then engineered to express a “chimeric antigen receptor” or CAR that targets AML remaining in your body.
Relapsed and refractory AML
When AML returns, it is called relapsed AML. AML that is resistant at the beginning of treatment or that becomes resistant after being treated for a length of time is called refractory AML. Drug therapy, an allogeneic stem cell transplant or a clinical trial may be available treatment options.
Drug therapies for ALLThese therapies may be used alone or in combination.
|asparaginase erwinia chrysanthemi (Erwinaze)|
|asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze)|
|brexucabtagene autoleucel (Tecartus)|
|calaspargase pegol – mknl (Asparlas)|
|doxorubicin hydrochloride (Adriamycin)|
|imatinib mesylate (Gleevec)|
|inotuzumab ozogamicin (Besponsa)|
|mercaptopurine (Purinethol, Purixan)|
As of 10/13/21